HomeMy WebLinkAboutBuilding Permit Application Not Applicable
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:
Name: Name.*
Address: Address:
City, State: City: State:
Zip: Phone: Zip: Phone;
FEE SIMPLE TITLE HOLDER-. Not Applicable, BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip-- Phone: Zip: Phone:
OWNER/CONTRAC'T'OR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or Installation has commenced prior to the issuance of a permit.
St.Lucie Coun makes no representation that is granting a ermit will authorize the ermit holder to build the subject structure
-which is in convict with any applicable Home Owners Association rules,bylaws or anc covenants that may restrict or prohibit such
structure.Please consult with your Home owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory,uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the Jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recon ' p!your Notice of Commencement.
'Signature of Owner[Agent/I essee Signature of Contractor License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF COUNTY OF__-�7��
The forgoing instrument was acknowledged before me The forgoing instrument 9 as acknowledged,�efore me
this_A LA day of 49e YL 20 -b
by this bj,�,day of 10,6Y 1261f-b
61
(Name of person acknowledging) (Name of person acknowledging)
.'(-Signature of Notary_OR
Produced Identificati n Personally Known S Florida (signature of Notary Public-State drida)
PersonallKnown6 —OR Produced identificationy
Type of identification Produced Type of Identification
'0 �;Hft-ME B.EN111.11 &sRy P&P,
ed
MY 0 MIMIC N EE 8592E
Commission No. myMMMWONO :ommlisiion No.CK11511VIII
EXPIRES:Ap r
0 A,241
orrL 94rAdTWJp*JN 5XPIRES:April 4,2017
REVIEWS FRONT ZONING. ' SUPERVISOR, PIANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW. REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev,7/2014
A4